Healthcare Provider Details

I. General information

NPI: 1780306852
Provider Name (Legal Business Name): ANNA ENGLISH WISTED CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HOSPITAL BLVD
ROSWELL GA
30076-4915
US

IV. Provider business mailing address

16 REVIVAL ST
ROSWELL GA
30075-4801
US

V. Phone/Fax

Practice location:
  • Phone: 678-772-7577
  • Fax:
Mailing address:
  • Phone: 678-772-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN254819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: